AIDS fatigue: a dangerous diagnosis

Indian sandartist Sudersan Pattnaik gives the final touches to a sand sculpture on the eve of World AIDS Day, an annual event to raise awareness about HIV/AIDS.

Indian sandartist Sudersan Pattnaik gives the final touches to a sand sculpture on the eve of World AIDS Day, an annual event to raise awareness about HIV/AIDS. (Kumar Strdel / AFP / Getty Images)

Warner C. Greene

I saw my first AIDS case in 1981, the year the disease was identified. And for most of the time since then, I've conducted laboratory research to better understand the precise mechanisms by which the virus HIV causes AIDS.

Lately, however, I've been equally worried about a related condition that is prevalent, persistent and threatens to bankrupt us. People in my world call it AIDS fatigue.

AIDS fatigue has several telltale symptoms. One is thinking that the AIDS crisis is under control. Another is believing that AIDS is someone else's problem, while still another is assuming that antiretroviral medications cure HIV/AIDS. All three notions, unfortunately, are false.

World AIDS Day on Sunday is a great opportunity to begin treating these malignant misconceptions, which we must do to address one of the most lethal pandemics ever to strike mankind. As a global community, we are not supplying — and may not even be able to afford to supply — enough of the lifesaving drugs required to prevent an HIV infection from progressing to AIDS for all the people who need them.

Our best option is to cure this disease — thereby eliminating the need to fund a lifetime of expensive medications for tens of millions of people — while also developing a vaccine to prevent new infections. And to do this, we must first treat AIDS fatigue with the only medicine known to address it: facts.

Since the beginning of the epidemic, AIDS-related illnesses have killed 36 million people, a number equal to the entire population of Canada. UNAIDS estimated recently that the rate of new infections is finally slowing. This is an excellent trend, but it's important to remember that the epidemic will continue to expand in the absence of a cure. HIV infected an additional 2.3 million people in 2012 alone.

Around the world, no one is spared. Today, nearly 1% of the adult population carries the HIV virus. It infects slightly more women than men, and more than 9% of those with the virus are children. But because more than 70% of new infections occur in sub-Saharan Africa, many Americans think of it as a distant problem. They don't seem to realize that the epidemic continues to strike close to home too.

In 2011, Los Angeles County reported 1,880 new HIV diagnoses, accounting for 38% of California's 4,950 HIV diagnoses reported in that year. And a full 43% of the 80,000 Angelenos who have contracted the virus since its discovery are now dead. Nationwide, meanwhile, the number of people living with HIV could increase as much as 38% between 2010 and 2020, costing an additional $128 billion to $237 billion in healthcare costs, according to the Centers for Disease Control and Prevention.

Indeed, those unmoved by the human suffering this disease causes might be interested to learn of the effect HIV/AIDS has on their pocketbooks. In 2010, the average U.S. lifetime HIV-treatment bill was calculated at $380,000 per person. That cost is borne by all of us through higher insurance rates and tax dollars.

Medications have saved millions of lives, but these drugs do not cure HIV/AIDS. And many who need them are not getting them. More than 20% of what the federal government spends on AIDS supports critical international programs such as the President's Emergency Plan for AIDS Relief. The program has been highly effective in battling the epidemic in Africa. But we still live in a world in which not all those who need treatment can get it, particularly in sub-Saharan Africa, where the pandemic is most widespread and money for treatment is scarce. For example, only 18% of HIV-positive pregnant women are being treated with crucially important antiretroviral drugs in Nigeria, home to the world's second-largest population of people with HIV.

All this points to the need for a cure. In addition to being a global cause for celebration, a cure for HIV/AIDS would eliminate the need to spend billions of dollars on lifelong, lifesaving treatments for the 35 million who are already infected.

Research to produce a vaccine or a cure isn't cheap, however. And with sequestration, government shutdowns and renewed fiscal constraints, research funds are increasingly difficult to come by. We have to remember that spending now — whether through increased government grants, insightful philanthropy or bold investments from pharmaceutical firms — will more than pay for itself down the road.

The scientific community has made tremendous strides against this disease. And a recent flurry of news reports — including stories about the so-called Berlin Patient, the Mississippi Baby, France's Visconti cohort and two Boston men whose viral load became undetectable after stem cell transplants — has given us renewed hope for a cure. But it will take a renewed commitment of research funds if we are deliver on that hope. We are unlikely to put an end to the disease if we allow AIDS fatigue to take hold.

Warner C. Greene is a physician and the director of virology and immunology research at the Gladstone Institutes in San Francisco.